Related Experiment Videos
beta-Tryptase measurements post-mortem in anaphylactic deaths and in controls
1Institute of Forensic Medicine, University Hospital, Linköping, Sweden. erik.edston@rm.rmv.se
Forensic Science International
|August 26, 1998
Summary
Mast cell tryptase measurement in post-mortem blood aids in diagnosing anaphylactic deaths. Optimal results are achieved using a 10 µg/L cut-off, with femoral blood sampling recommended for accuracy.
Area of Science:
- Forensic Pathology
- Toxicology
- Immunology
Background:
- The diagnostic reliability of post-mortem mast cell tryptase (MCT) levels for anaphylactic deaths is debated due to potential elevations in non-anaphylactic fatalities.
- Elevated MCT concentrations have been observed in control cases with causes of death like myocardial infarction and trauma, questioning its specificity.
Purpose of the Study:
- To evaluate the sensitivity and specificity of MCT measurements in post-mortem blood for diagnosing anaphylactic or anaphylactoid deaths (AADs).
- To determine an optimal cut-off value for MCT to differentiate AADs from other causes of death.
- To assess MCT levels in various non-AAD death categories, including trauma, SIDS, and heroin-related deaths, as well as unexplained deaths.
Main Methods:
- MCT levels were measured in post-mortem blood samples from 193 cases, comprising 176 known cause of death, 10 unexplained deaths, and 7 AADs.
- Binary logistic regression analysis was employed to calculate sensitivity and specificity at various MCT cut-off values.
- Comparison of MCT levels between heart and femoral blood samples was conducted.
Main Results:
- An optimal MCT cut-off value of 10 µg/L was identified, yielding a sensitivity of 86% and a specificity of 88% for diagnosing AADs.
- Elevated MCT levels were found in a significant proportion of non-AAD cases, including traumatic deaths (35%), SIDS (35%), heroin-related deaths (32%), and unexplained deaths (40%).
- Femoral blood sampling showed a lower incidence of elevated MCT (10%) compared to heart blood (22%) in control cases.
Conclusions:
- Post-mortem MCT measurement is a valuable tool for confirming death from AADs, with femoral blood sampling being the preferred method.
- While MCT is a useful indicator in unexplained deaths, the diagnosis should not rely solely on this test.
- The study highlights the importance of considering elevated MCT levels in various non-anaphylactic conditions.